Blood Res.  2020 Mar;55(1):27-34. 10.5045/br.2020.55.1.27.

Similar transplant outcomes between haploidentical and unrelated donors after reduced-intensity conditioning with busulfan, fludarabine, and anti-thymocyte globulin in patients with acute leukemia or myelodysplastic syndrome

  • 1Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
  • 2Center for Medical Innovation, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.
  • 3Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
  • 4Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.


Although T-cell-replete hematopoietic cell transplantation (HCT) from haploidentical donors (HIDs) using anti-thymocyte globulin (ATG) has shown promising outcomes, previous studies often adopted heterogenous graft sources and conditioning.
We retrospectively compared HCT outcomes from 62 HIDs, 36 partially-matched unrelated donors (PUDs), and 55 matched unrelated donors (MUDs) in patients with acute leukemia or myelodysplastic syndrome using the same graft source of peripheral blood and a reduced intensity conditioning of busulfan, fludarabine, and ATG.
The estimates of 3-yr disease-free survival (DFS) and overall survival (OS) rates were not significantly different among the MUD, HID, and PUD groups, at 46%, "41%, and 36%" for the DFS rate (P=0.844), and 55%, 45%, and 45% for the OS rate (P=0.802), respectively. Cumulative incidence of relapse and non-relapse mortality at 3 yr was similar among different donor types. Subsequent multivariable analyses showed that the sex of the patient (male) and a high/very high disease risk index were independently associated with poorer DFS and OS, while the donor type was not.
T-cell replete HCT from HIDs using an ATG-containing reduced intensity conditioning regimen may be a reasonable option in the absence of matched related donors in patients with acute leukemia or myelodysplastic syndrome.


Haploidentical stem cell transplantation; HLA-matched unrelated donor; Reduced-intensity conditioning; Anti-thymocyte globulin

MeSH Terms

Antilymphocyte Serum*
Cell Transplantation
Disease-Free Survival
Myelodysplastic Syndromes*
Retrospective Studies
Tissue Donors
Unrelated Donors*
Antilymphocyte Serum


  • Fig. 1 Survival curves for the overall population. Graft-vs.-host disease (GVHD)-free, relapse-free survival (A). Disease-free survival (B). Overall survival (C). GVHD-free, relapse-free survival by donor types (D). Disease-free survival by donor types (E). Overall survival by donor types (F). GVHD-free, relapse-free survival by disease risk index (G). Disease-free survival by disease risk index (H). Overall survival by disease risk index (I). Abbreviations: HID, haploidentical familial donors; MUD, matched unrelated donors; PUD, partially matched unrelated donors.

  • Fig. 2 Cumulative incidence curves by donor type. Acute graft-vs.-host disease of grade III–IV (A). Chronic graft-vs.-host disease requiring systemic treatment (B). Relapse (C). Non-relapse mortality (D).Abbreviations: HID, haploidentical familial donors; MUD, matched unrelated donors; PUD, partially matched unrelated donors.


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